Non-alcoholic Wernicke encephalopathy: great masquerader

Abstract

Thiamine is an important coenzyme, which is essential for metabolism and maintaining cellular osmotic gradient. Thiamine deficiency can cause focal lactic acidosis, alteration of the blood–brain barrier and the production of free radicals through cell death by necrosis and apoptosis. Wernicke encephalopathy (WE) is a clinical diagnosis. Cytotoxic and vasogenic oedema are the most typical neuroimaging findings of WE, presenting as bilateral symmetrical hyperintense signals on T2-weighted MR images. MRI is not necessary for the diagnosis of WE, but it can be helpful in ruling out alternative diagnosis. We present the case of an 61-year-old man with the history of class II obesity presenting with diplopia, dysarthria and vertigo, confirmed to be non-alcoholic WE. We aim to highlight the occurrence of WE in patients with large bowel resection though. Delay in diagnosis, particularly in obese individuals due to lack of suspicion, can lead to grim prognosis.

A Case of Wernicke Encephalopathy Secondary to Anorexia Nervosa Complicated by Refeeding Syndrome and Takotsubo Cardiomyopathy

“…Malnutrition should be closely monitored, particularly in anorexic patients with purging behavior, as well as in patients who have recently had bariatric surgery [ 7 ]. WE classically presents with ataxia, ophthalmoplegia, and global confusion, but this is only present in 16–20% of cases, and atypical presentations are more common in nonalcoholic WE, as in our patient, with lethargy and ophthalmoplegia [ 1 ]. Once the diagnosis is suspected, the preferred imaging modality in patients with suspected nonalcoholic WE is MRI, although a normal MRI does not definitely rule out WE [ 8 ].…”

“…Our case also demonstrates many of the complications that can arise when treating a patient with AN, which is rarely reported in the literature. Early detection of WE and treatment with thiamine is very important, as these patients can progress to Korsakoff syndrome, which has an even higher mortality rate [ 1 ]. Early intervention and prompt treatment can change the course of this disease, prevent patient suffering, and provide a chance for functional recovery.…”

“…Wernicke encephalopathy (WE) is most often associated with chronic alcohol abuse disorder, however nonalcoholic causes of Wernicke’s encephalopathy, such as anorexia nervosa, are also infrequently reported throughout the literature [ 1 – 3 ]. Anorexia nervosa (AN) is a psychiatric disorder characterized by a decreased body mass index (BMI) due to severe food deprivation.…”

A Case Report of Nonalcoholic Gayet-Wernicke Encephalopathy: Don’t Miss Thiamine

“…5 It has also been reported in postoperative patients who underwent bariatric 2,5,6 or gastrointestinal resection surgeries 2,5-7 and those on prolonged TPN. [6][7][8] However, diagnosis of nonalcoholic WE is often difficult, with 75%-80% patients misdiagnosed. 1,3,5 In 11% of patients, WE has no symptoms.…”

Wernicke Korsakoff syndrome in a teenage female as a complication of COVID‐19

“…Unfortunately, this triad is only present in up to 33% of cases leading to it being underdiagnosed and undertreated. 1 , 2 , 3 , 4 A total of 23% of cases of WE are non‐alcoholic with a total prevalence from all causes of up to 2.8% in developed countries. 1 , 3 , 4 We present the case of a 14‐year‐old female who developed thiamine deficiency, leading to a diagnosis of WE, secondary to poor oral intake after a change in her taste from a coronavirus disease 2019 (COVID‐19) infection.…”